| NPI | 1861552705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |