| NPI | 1558061432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA NA) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-05-03 |