| NPI | 1295603132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management (Licence: FL CBHCMS0102846) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS0102846) |
| Enumeration Date | 2025-10-23 |
| Last Update Date | 2026-07-10 |