| NPI | 1194331181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MD A00167290) |
| 376K00000X Nurse's Aide (Licence: MD A00167290) | |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2023-06-02 |