| NPI | 1679329759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant (Licence: LA 1758001925) |
| Additional Taxonomies | 385H00000X Respite Care (Licence: LA 770641488) |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2024-04-29 |