| NPI | 1457056723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2023-04-14 |