| NPI | 1356766836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 21733-P) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2025-11-07 |