| NPI | 1790253052 |
|---|---|
| Former Name | JAYTON TIDWELL |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2021-10-13 |