| NPI | 1770342644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: KY 2055482) |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-03-14 |