| NPI | 1104553379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: TX 000000) |
| 171M00000X Case Manager/Care Coordinator | |
| 1744P3200X Specialist, Prosthetics Case Management (Licence: TX 000000) | |
| Enumeration Date | 2022-08-06 |
| Last Update Date | 2025-05-06 |