| NPI | 1235880808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM.0104912) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL CBHCMS.0102658) |
| 251C00000X Day Training, Developmentally Disabled Services | |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2024-03-13 |