| NPI | 1790425106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DE L2-0011827) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 251E00000X Home Health | |
| 253Z00000X In Home Supportive Care | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2022-04-04 |