| NPI | 1720681794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver |
| Additional Taxonomies | 251X00000X |
| 3747P1801X Technician, Personal Care Attendant | |
| 376J00000X Homemaker | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2020-11-20 |