| NPI | 1205633211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Additional Taxonomies | 251E00000X Home Health |
| 253Z00000X In Home Supportive Care | |
| 347C00000X Private Vehicle | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2025-07-16 |