| NPI | 1932575636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MN 388010) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 376G00000X Nursing Home Administrator (Licence: MN 388010) | |
| 376J00000X Homemaker | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2020-05-05 |