| NPI | 1104292143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: PA 27053601) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: PA 27053601) |
| 373H00000X Day Training/Habilitation Specialist (Licence: PA 27053601) | |
| 3747P1801X Technician, Personal Care Attendant (Licence: PA 27053601) | |
| 376J00000X Homemaker (Licence: PA 27053601) | |
| 376K00000X Nurse's Aide (Licence: PA 27053601) | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2015-08-13 |