| NPI | 1649105941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 3747A0650X Technician, Attendant Care Provider | |
| Enumeration Date | 2026-06-17 |
| Last Update Date | 2026-07-10 |