| NPI | 1043708829 |
|---|---|
| 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: MD HHA13611) | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-07-28 |