| NPI | 1104566256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 251E00000X Home Health |
| 253Z00000X In Home Supportive Care | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-03-31 |