| NPI | 1265304133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: Aps.007136) |
| 251B00000X Case Management | |
| Enumeration Date | 2025-09-20 |
| Last Update Date | 2025-11-19 |