| NPI | 1578348603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2025-05-09 |