| NPI | 1356013213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2025-05-20 |