| NPI | 1053955740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2024-01-09 |