| NPI | 1922628700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MN DHS-6189Z) |
| Additional Taxonomies | 251G00000X Hospice Care, Community Based (Licence: MN DHS-6189Z) |
| 253Z00000X In Home Supportive Care (Licence: MN DHS-6189Z) | |
| 372600000X Adult Companion (Licence: MN DHS-6189Z) | |
| 3747A0650X Technician, Attendant Care Provider (Licence: MN DHS-6189Z) | |
| 374U00000X Home Health Aide (Licence: MN DHS-6189Z) | |
| 385H00000X Respite Care (Licence: MN DHS-6189Z) | |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2022-08-23 |