| NPI | 1497195002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171W00000X Contractor |
| 174H00000X Health Educator | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2013-06-27 |