| NPI | 1972219764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9486139) |
| 163WH0200X Registered Nurse, Home Health (Licence: FL 9486139) | |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2023-01-25 |