| NPI | 1659337749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G 32293) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA G32293) |
| 332U00000X Home Delivered Meals (Licence: CA G32293) | |
| 251X00000X Supports Brokerage (Licence: CA G32293) | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA G32293) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2025-09-08 |