| NPI | 1578171427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: FL H-4A51D6) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: 20-117230) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2024-03-05 |