| NPI | 1790157121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor, School |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2015-10-25 |
| Last Update Date | 2015-10-25 |