| NPI | 1891486312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 347E00000X Transportation Broker | |
| 251X00000X | |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-05-16 |