| NPI | 1538954029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251E00000X Home Health |
| 253Z00000X In Home Supportive Care | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 171M00000X Case Manager/Care Coordinator | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 172A00000X Driver | |
| 347C00000X Private Vehicle | |
| 342000000X Transportation Network Company | |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2026-01-05 |