| NPI | 1174045686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 11571) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2025-04-22 |