| NPI | 1639967177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2025-04-25 |
| Last Update Date | 2025-04-25 |