| NPI | 1053048140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2022-08-08 |