| NPI | 1386204410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 251J00000X Nursing Care |
| 253J00000X Foster Care Agency | |
| 385H00000X Respite Care | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2019-06-20 |