| NPI | 1730831520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 251E00000X Home Health (Licence: VA 251E00000X) |
| 251E00000X Home Health | |
| Enumeration Date | 2022-01-22 |
| Last Update Date | 2022-01-22 |