| NPI | 1972005064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant (Licence: TX 019605) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2020-10-30 |