| NPI | 1760276216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 372600000X Adult Companion | |
| Enumeration Date | 2025-04-08 |
| Last Update Date | 2025-07-15 |