| NPI | 1376891960 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator | 
| Additional Taxonomies | 374U00000X Home Health Aide | 
| 172V00000X Community Health Worker | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2012-08-29 | 
| Last Update Date | 2025-09-10 |