| NPI | 1700254273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MD R2448R) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD MH1584) |
| 376K00000X Nurse's Aide (Licence: MD NS1309006) | |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-15 |