| NPI | 1619040037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: FL 690453096) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL 690453098) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-09 |