| NPI | 1750635587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 174400000X Specialist | |
| 175T00000X Peer Specialist | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2019-02-19 |