| NPI | 1982261350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: NE 4086921) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care (Licence: NE 4086921) |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2019-05-23 |