| NPI | 1770891095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OK 302070) |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2015-01-14 |