| NPI | 1063130631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: NC HC6674) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: NC HC6674) |
| 374U00000X Home Health Aide (Licence: NC HC6674) | |
| 385H00000X Respite Care (Licence: NC HC6674) | |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-18 |