| NPI | 1700773074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker |
| 101Y00000X Counselor | |
| Enumeration Date | 2025-06-19 |
| Last Update Date | 2025-06-19 |