| 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 |