| NPI | 1568241891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171W00000X Contractor |
| 172A00000X Driver (Licence: VA T67133866) | |
| 3747P1801X Technician, Personal Care Attendant | |
| 226000000X Recreational Therapist Assistant | |
| 374U00000X Home Health Aide | |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2023-10-06 |