| NPI | 1396452330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OK 317198) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OK 134121) |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2023-08-08 |