| NPI | 1750112918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 374U00000X Home Health Aide | |
| 376J00000X Homemaker | |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2024-08-09 |