| NPI | 1962006809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 172A00000X Driver |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| 376J00000X Homemaker | |
| Enumeration Date | 2020-11-22 |
| Last Update Date | 2020-11-22 |