| NPI | 1578803052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker (Licence: FL 232604) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: FL 232604) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2013-02-21 |