| NPI | 1942559992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker |
| 171W00000X Contractor | |
| 172A00000X Driver | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2013-09-07 |