| NPI | 1487473682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies | |
| 372500000X Chore Provider | |
| 374U00000X Home Health Aide | |
| 171W00000X Contractor | |
| 171WH0202X Contractor Home Modifications | |
| 251E00000X Home Health | |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2024-10-07 |