| NPI | 1477005411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: MN 264457487) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MN 1071447) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-26 |