| NPI | 1922368216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 132700000X Dietary Manager |
| 133N00000X Nutritionist | |
| 172A00000X Driver | |
| 173000000X Legal Medicine | |
| 305R00000X Preferred Provider Organization | |
| 305S00000X Point of Service | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |