| NPI | 1497577829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374700000X Technician (Licence: MD MT0158723) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-31 |