| NPI | 1710444930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MN 1094859-1-hcbs) |
| Additional Taxonomies | 174200000X |
| 374U00000X Home Health Aide (Licence: MN 1096660-1-AFC) | |
| Enumeration Date | 2019-02-24 |
| Last Update Date | 2019-02-25 |