| NPI | 1992390355 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: NY 682763680) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 682763680) | |
| Enumeration Date | 2021-03-07 |
| Last Update Date | 2021-03-07 |