| NPI | 1750866364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2021-05-27 |