| NPI | 1912510918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2021-06-23 |