| NPI | 1073109021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 372600000X Adult Companion |
| 3747A0650X Technician, Attendant Care Provider | |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2020-12-14 |