| NPI | 1437724721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 101674) |
| Additional Taxonomies | 251B00000X Case Management (Licence: FL 101674) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-05-20 |