| NPI | 1114596889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 251E00000X Home Health |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2022-01-20 |