| NPI | 1073261988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 390200000X) |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2022-07-18 |