| NPI | 1821752221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2021-10-22 |
| Last Update Date | 2022-07-05 |