| NPI | 1205331147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider (Licence: AR5640) |
| 3747P1801X Technician, Personal Care Attendant (Licence: AR5640) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2021-12-29 |