| NPI | 1316410715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 5058) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: LA 20170345) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2025-09-04 |