| NPI | 1770790578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 1992-120) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: WI 104876-030) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |