| NPI | 1811502636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 1744R1102X Specialist, Research Study | |
| 174H00000X Health Educator | |
| 175T00000X Peer Specialist | |
| 251S00000X Community/Behavioral Health | |
| 251V00000X Voluntary or Charitable | |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2023-11-27 |