| NPI | 1427925080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 226000000X Recreational Therapist Assistant |
| Enumeration Date | 2025-10-20 |
| Last Update Date | 2025-10-20 |