| NPI | 1104781517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker (Licence: AZ D08723554) |
| Additional Taxonomies | 172A00000X Driver (Licence: AZ D08723554) |
| 3747P1801X Technician, Personal Care Attendant (Licence: AZ D08723554) | |
| Enumeration Date | 2025-12-17 |
| Last Update Date | 2025-12-17 |