| NPI | 1710524988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 305S00000X Point of Service | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2019-12-08 |