| NPI | 1780307058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic |
| 174400000X Specialist | |
| 251E00000X Home Health | |
| 3747A0650X Technician, Attendant Care Provider | |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-09-22 |