| NPI | 1649924317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: UT F23-106240) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2026-08-13 |