| NPI | 1942080742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 104100000X Social Worker | |
| 171W00000X Contractor | |
| 374U00000X Home Health Aide | |
| 374U00000X Home Health Aide | |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2023-10-28 |