| NPI | 1295371557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2024-07-12 |