| NPI | 1891490041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2025-04-29 |