| NPI | 1609506732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: LA 325110) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2023-11-06 |