| NPI | 1295361731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246Y00000X Spec/Tech, Health Info |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2024-07-23 |