| NPI | 1073202131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker |
| 172V00000X Community Health Worker | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2025-12-02 |