| NPI | 1962212340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: AZ 166955) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: AZ 145292) |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2025-05-15 |