| NPI | 1679765754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: IN 31-01-07-04508) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: IN 31-03-07-01542) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2007-08-13 |