| NPI | 1568337137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: UT F22-101891) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: UT f23-108644) |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-10-06 |