| NPI | 1285395038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: UT CPSSCT-01958) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2024-06-25 |