| NPI | 1396630117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant (Licence: VA HCO-0005909) |
| Additional Taxonomies | 251E00000X Home Health (Licence: VA HCO-0005909) |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: VA HCO-0005909) | |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2025-07-22 |