| NPI | 1134991581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: GA 070183330) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2025-07-14 |