| NPI | 1043771629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 174H00000X Health Educator |
| 175T00000X Peer Specialist | |
| 251K00000X Public Health or Welfare | |
| 251S00000X | |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |