| NPI | 1073267100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 171W00000X Contractor | |
| 174200000X Meals | |
| 251E00000X Home Health | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2025-05-14 |