| NPI | 1265000103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2023-08-07 |