| NPI | 1942755509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: FL none) |
| Additional Taxonomies | 172A00000X Driver (Licence: FL p630139743438) |
| 376J00000X Homemaker (Licence: FL 234582) | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2016-11-04 |