| NPI | 1992001705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: KS 33-2427-120) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2011-01-27 |