| NPI | 1780388975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2025-01-29 |