| NPI | 1750053252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171WH0202X Contractor, Home Modifications |
| 172A00000X Driver | |
| 372600000X Adult Companion | |
| Enumeration Date | 2021-10-02 |
| Last Update Date | 2021-10-02 |