| NPI | 1114750825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2025-10-14 |