| NPI | 1750794558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: FL r163110833400) |
| 253Z00000X In Home Supportive Care | |
| 372600000X Adult Companion | |
| 376J00000X Homemaker | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2014-10-04 |