| NPI | 1003226739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2024-01-25 |