| NPI | 1407193196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 224931) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2016-06-02 |