| NPI | 1174251680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2023-07-25 |