| NPI | 1639298185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA NA) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA NA) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |