| NPI | 1801600523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: VA HCO-005691) |
| Additional Taxonomies | 251E00000X Home Health (Licence: VA HCO-005691) |
| 385H00000X Respite Care (Licence: VA HCO-005691) | |
| 385HR2060X Respite Care Respite Care, Mental Retardation and/or Developmental Disabilities (Licence: VA HCO-005691) | |
| 163WH0200X Registered Nurse Home Health (Licence: VA HCO-005691) | |
| 385HR2065X Respite Care Respite Care, Physical Disabilities, Child (Licence: VA HCO-005691) | |
| Enumeration Date | 2025-02-04 |
| Last Update Date | 2025-02-18 |