| NPI | 1407101017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2025-10-20 |