| NPI | 1104633742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 172A00000X Driver | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2024-12-17 |
| Last Update Date | 2024-12-17 |