| NPI | 1972131787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 251E00000X Home Health (Licence: MO 285) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2021-06-30 |