| NPI | 1235497579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant (Licence: MA 3747P1801X) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MA 374U00000X) |
| 376J00000X Homemaker (Licence: MA 376J00000X) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2012-04-24 |