| NPI | 1780942979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: VA HCO12250) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: VA HCO12250) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2012-04-25 |