| NPI | 1720119001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: KY 164776) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2014-05-29 |