| NPI | 1700121035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 171M00000X Case Manager/Care Coordinator | |
| 172A00000X Driver | |
| 172V00000X Community Health Worker | |
| 225800000X Recreation Therapist | |
| 372500000X Chore Provider | |
| 374K00000X | |
| 374T00000X Religious Nonmedical Nursing Personnel | |
| Enumeration Date | 2012-11-27 |
| Last Update Date | 2024-06-06 |