| NPI | 1205275393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: 00003927) |
| 225400000X Rehabilitation Practitioner (Licence: 00003927) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2014-01-23 |