| NPI | 1639991318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MD RSA-02483) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MD RSA-02483) |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2026-04-06 |