| NPI | 1124235106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2014-10-24 |