| NPI | 1700140761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC 143294) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2025-12-01 |