| NPI | 1407541857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker |
| 251E00000X Home Health | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-06-13 |