| NPI | 1417141920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: AR L38028) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2009-10-12 |