| NPI | 1861781098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider (Licence: CA PT 33350) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2024-07-02 |