| NPI | 1770357543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 372500000X Chore Provider |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI 4703117964) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-11-29 |