| NPI | 1861952384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201804547RN) |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2019-03-29 |