| NPI | 1346123940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2025-07-30 |
| Last Update Date | 2026-08-07 |