| NPI | 1194179622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172A00000X Driver |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2016-04-21 |