| NPI | 1891038402 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator | 
| Additional Taxonomies | 251E00000X Home Health | 
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2013-04-02 | 
| Last Update Date | 2023-07-28 |