| NPI | 1760365613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2607454-TRNE) |
| Enumeration Date | 2025-07-29 |
| Last Update Date | 2026-02-04 |