| NPI | 1407550825 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 374U00000X Home Health Aide | 
| Additional Taxonomies | 251S00000X Community/Behavioral Health | 
| 106S00000X Behavior Technician | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-03-29 | 
| Last Update Date | 2025-10-08 |