| NPI | 1093253015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 3747P1801X Technician Personal Care Attendant | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2021-07-10 |