| NPI | 1083202196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| 347C00000X Private Vehicle | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-01-05 |