| NPI | 1679891873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MS 1671) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2021-06-28 |