| NPI | 1992041545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 7234668962) |
| Enumeration Date | 2012-12-28 |
| Last Update Date | 2017-11-09 |