| NPI | 1609627439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
| Additional Taxonomies | 251C00000X |
| 251X00000X Supports Brokerage | |
| 253Z00000X In Home Supportive Care | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2024-03-29 |
| Last Update Date | 2024-04-11 |