| NPI | 1417376096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| 344600000X Taxi | |
| 347C00000X Private Vehicle | |
| 347E00000X Transportation Broker | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| 101Y00000X Counselor | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2014-06-09 |