| NPI | 1912550542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: NY 000147-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 000147-1) |
| 174H00000X Health Educator (Licence: NY 000147-1) | |
| 246Z00000X Specialist/Technologist, Other (Licence: NY 000147-1) | |
| 2472E0500X Technician, Other, EEG (Licence: NY 000147-1) | |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2023-11-27 |