| NPI | 1841794054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 268391) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2019-04-16 |