| NPI | 1790092138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: NY 884958991) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NY 006002001) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2010-09-07 |