| NPI | 1174975221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2025-08-06 |