| NPI | 1194460634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: WV 18-913) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2026-06-24 |