| NPI | 1013478940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 19-CRM-076) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2022-02-14 |