| NPI | 1750684841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: NV 6048PCS-6) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: NV 6048PCS-6) |
| 372500000X Chore Provider (Licence: NV 6048PCS-6) | |
| 374U00000X Home Health Aide (Licence: NV 6048PCS-6) | |
| Enumeration Date | 2010-12-10 |
| Last Update Date | 2018-03-17 |