| NPI | 1750066650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2024-08-21 |