| NPI | 1942420765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: TN 4785756) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL 850390) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |