| NPI | 1144111998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 174H00000X Health Educator |
| 246Z00000X Specialist/Technologist, Other | |
| 251300000X Local Education Agency (LEA) | |
| 251B00000X Case Management | |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2025-07-10 |