| NPI | 1770996365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 146M00000X Emergency Medical Technician, Intermediate (Licence: AK 10035002) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2017-03-03 |