| NPI | 1487430732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347E00000X Transportation Broker |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker Clinical | |
| 1041S0200X Social Worker School | |
| 2472R0900X Technician, Other Renal Dialysis | |
| 342000000X | |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2023-09-04 |