| NPI | 1770039000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: TX 017944) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: TX 017944) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2022-07-21 |