| NPI | 1215745054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2024-12-26 |
| Last Update Date | 2025-04-09 |