| NPI | 1104427616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 347C00000X Private Vehicle |
| 347E00000X Transportation Broker | |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-11-03 |