| NPI | 1063290229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2025-07-02 |