| NPI | 1912549957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2025-10-17 |