| NPI | 1518536176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NM 1097) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2025-03-05 |