| NPI | 1205531043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-07-19 |