| NPI | 1851974042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 690690) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 690690) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2023-09-11 |