| NPI | 1043892367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2021-05-03 |