| NPI | 1720893878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2025-02-07 |
| Last Update Date | 2025-02-12 |