| NPI | 1346668969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: FL 592289560) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL 592389561) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2014-08-04 |