| NPI | 1659736213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MI 2000017848) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2018-02-07 |