| NPI | 1700749025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2607625) |
| Enumeration Date | 2025-12-04 |
| Last Update Date | 2026-05-15 |