| NPI | 1417495771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: LA HC0011912) |
| 261QA0600X Clinic/Center, Adult Day Care | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2023-04-20 |