| NPI | 1215333711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801096999) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2024-12-28 |