| NPI | 1043711971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 95160727) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 261657) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2018-11-30 |