| NPI | 1871285445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2023-05-30 |