| NPI | 1649047069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 372500000X Chore Provider (Licence: PA 71193601) |
| 376J00000X Homemaker (Licence: PA 71193601) | |
| 385H00000X Respite Care (Licence: PA 71193601) | |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2023-12-06 |