| NPI | 1295134666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171WV0202X Contractor, Vehicle Modifications |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |