| NPI | 1710264890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: AR T01708) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2023-01-30 |