| NPI | 1699649251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MS 6239) |
| Additional Taxonomies | 332U00000X Home Delivered Meals (Licence: MS 6112) |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-10-06 |