| NPI | 1770317851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| 347B00000X Bus | |
| 347C00000X Private Vehicle | |
| 172A00000X Driver | |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-08-29 |