| NPI | 1780016618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician Personal Care Attendant |
| Additional Taxonomies | 3747A0650X Technician Attendant Care Provider |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2013-08-01 |