NPI | 1730672890 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
Additional Taxonomies | 101Y00000X Counselor (Licence: KY 9519) |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2018-06-12 |
Last Update Date | 2024-03-04 |