| NPI | 1548678840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CO PN0048083) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2014-07-31 |