NPI | 1659050060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 172A00000X Driver (Licence: ND FOO601177) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
175T00000X Peer Specialist | |
Enumeration Date | 2023-07-13 |
Last Update Date | 2023-08-01 |