| NPI | 1659088821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2025-07-23 |