| NPI | 1376051326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA CG60757127) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2019-09-04 |