| NPI | 1275242612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 376K00000X Nurse's Aide (Licence: MD A00204083) | |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2025-07-22 |