| NPI | 1528731213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 376K00000X Nurse's Aide (Licence: CNA20212708) | |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2023-07-25 |