| NPI | 1174949259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2025-10-14 |