| NPI | 1255925632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172A00000X Driver (Licence: AZ D055116420) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: AZ AZ12220) |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2021-02-25 |