| NPI | 1164248381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2024-12-20 |