| NPI | 1891194098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2020-01-29 |