| NPI | 1114339405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 372600000X Adult Companion |
| 374K00000X Religious Nonmedical Practitioner | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2014-05-21 |