| NPI | 1689470452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| 372600000X Adult Companion | |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-02-21 |