| NPI | 1699151977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251B00000X Case Management |
| 251X00000X Supports Brokerage | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2015-08-10 |