| NPI | 1528652617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care (Licence: NC HC5833) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2022-09-13 |