| NPI | 1629436191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 237700000X Hearing Instrument Specialist | |
| 305R00000X Preferred Provider Organization | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2016-10-18 |