| NPI | 1558002451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 133VN1301X Dietitian, Registered, Nutrition, Oncology |
| 3747A0650X Technician, Attendant Care Provider | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-04-14 |