| NPI | 1821816125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NV PRSS-INT-5169) |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2025-03-05 |