| NPI | 1548919749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-04-10 |