| NPI | 1679010516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OK 314211) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OK 131846) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2025-11-14 |