| NPI | 1033767173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 374U00000X Home Health Aide (Licence: DC 14613) | |
| Enumeration Date | 2019-09-02 |
| Last Update Date | 2023-08-08 |