| NPI | 1568283992 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator | 
| Additional Taxonomies | 172V00000X Community Health Worker | 
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2024-10-18 | 
| Last Update Date | 2025-09-18 |