| NPI | 1629600093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care (Licence: OK HC8114) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: OK HC8114) |
| 374U00000X Home Health Aide (Licence: OK HC8114) | |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2020-02-04 |