| NPI | 1770840308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 251S00000X | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2023-07-26 |