| NPI | 1023797867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101Y00000X Counselor (Licence: R1514390723) | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-01-16 |