| NPI | 1184971582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8688832-3102) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2013-11-25 |