| NPI | 1609643527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 010254040) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: LA 010254040) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2024-01-03 |