| NPI | 1104391390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376J00000X Homemaker (Licence: SC IHCP-0146) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: SC IHCP-0146) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2018-10-04 |