| NPI | 1609553155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OK 318182) |
| Additional Taxonomies | 376K00000X Nurse's Aide |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-08-24 |