| NPI | 1942076195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251X00000X |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 251300000X Local Education Agency (LEA) | |
| 374U00000X Home Health Aide | |
| 374U00000X Home Health Aide | |
| 376J00000X Homemaker | |
| 385H00000X Respite Care | |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2023-11-29 |