| NPI | 1548690597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: ND 1548690597) |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2021-10-15 |