| NPI | 1649601048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 174H00000X Health Educator | |
| 104100000X Social Worker | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2015-07-01 |