| NPI | 1790348068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: SC IHCP-0058) |
| Additional Taxonomies | 251E00000X Home Health (Licence: SC IHCP-0789) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2019-04-22 |