| NPI | 1215505094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 251X00000X Supports Brokerage | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2025-08-11 |