| NPI | 1013612043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225CX0006X Rehabilitation Counselor, Orientation and Mobility Training Provider (Licence: 4637) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2023-03-31 |