| NPI | 1063865913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R195288) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2025-11-06 |