| NPI | 1134761406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| 103TH0100X Psychologist, Health Service | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2019-10-08 |