| NPI | 1497549760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-04-09 |