| NPI | 1639948284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 101200000X | |
| 102X00000X Poetry Therapist | |
| 171400000X | |
| 171M00000X Case Manager/Care Coordinator | |
| 172A00000X Driver | |
| Enumeration Date | 2023-12-25 |
| Last Update Date | 2024-04-03 |