| NPI | 1265736698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic |
| 101Y00000X Counselor | |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2022-07-26 |