| NPI | 1164217246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 332U00000X Home Delivered Meals | |
| 347C00000X Private Vehicle | |
| 385H00000X Respite Care | |
| Enumeration Date | 2025-04-10 |
| Last Update Date | 2025-04-10 |