| NPI | 1285257998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 372600000X Adult Companion (Licence: PA 46233601) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: PA 46233601) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2020-05-28 |