| NPI | 1750983441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care (Licence: MN 1103105) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2021-02-13 |