| NPI | 1679009468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 372500000X Chore Provider |
| 372600000X Adult Companion | |
| 374T00000X Religious Nonmedical Nursing Personnel | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |