| NPI | 1790392652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171W00000X Contractor |
| 251E00000X Home Health | |
| 253Z00000X In Home Supportive Care | |
| 374U00000X Home Health Aide | |
| 372500000X Chore Provider | |
| 372600000X Adult Companion | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2024-05-11 |