| NPI | 1386113710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: WA CG60916552) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60916552) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2020-05-22 |