| NPI | 1902381221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: CA 00281602) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: CA 00968569) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2018-10-02 |