| NPI | 1679837140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2025-09-25 |