| 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 |