| NPI | 1508678152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 172A00000X Driver |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2025-01-21 |
| Last Update Date | 2025-01-21 |