| NPI | 1548037260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 1235674) |
| 405300000X Prevention Professional (Licence: MD 1234567) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2023-12-08 |