| NPI | 1205663804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172A00000X Driver | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-09-17 |