| NPI | 1720442510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 174400000X Specialist |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2022-09-13 |