| NPI | 1720774094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2025-01-13 |