| NPI | 1871391144 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: DC 1277718)  | 
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant | 
| Enumeration Date | 2025-03-04 | 
| Last Update Date | 2025-03-21 |