| NPI | 1396523049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 224Z00000X Occupational Therapy Assistant | |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2026-02-04 |