| NPI | 1649074006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-04-03 |