| NPI | 1538748678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 251B00000X Case Management | |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2021-04-20 |