| NPI | 1396386934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 374700000X Technician | |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2024-02-13 |