| NPI | 1669859518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: GA 060-R-1364) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: GA 060-R-1364) |
| 376K00000X Nurse's Aide (Licence: GA 060-R-1364) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |