| NPI | 1629949391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 347C00000X Private Vehicle |
| 376J00000X Homemaker | |
| 251X00000X Supports Brokerage | |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2025-09-16 |
| Last Update Date | 2025-09-16 |