| NPI | 1265023675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: FL CRPS100524) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2021-01-28 |