| NPI | 1659078582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: CA 002919919) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care (Licence: CA 002919919) |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2023-02-10 |