| NPI | 1619671724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-08-02 |