| NPI | 1245989730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-07-20 |