| NPI | 1376029009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: AR L056222) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: AR QBPH) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2018-07-16 |