| NPI | 1861198871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 372600000X Adult Companion |
| 172V00000X Community Health Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2026-03-11 |