| NPI | 1770941197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 175T00000X Peer Specialist | |
| 251B00000X Case Management | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2016-01-30 |
| Last Update Date | 2019-04-15 |