| NPI | 1912135559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WY 29479) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2011-07-26 |