| NPI | 1003074675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2025-11-13 |