| NPI | 1902243306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: TX A00854166) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: TX A00854166) |
| Enumeration Date | 2013-05-27 |
| Last Update Date | 2013-05-27 |