| NPI | 1790444602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 281328) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2024-03-18 |