| NPI | 1720395304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-09-02 |