| NPI | 1881473551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: AK 135982) |
| 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: ME 135982) | |
| Enumeration Date | 2023-09-22 |
| Last Update Date | 2024-02-24 |