| NPI | 1417801077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 172A00000X Driver |
| 347C00000X Private Vehicle | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2026-02-23 |
| Last Update Date | 2026-02-24 |