| NPI | 1194156539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: DC 14784) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2023-08-10 |