| NPI | 1730545831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC 11643) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: WA 11643) |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2016-01-06 |