| NPI | 1902775646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2025-10-31 |
| Last Update Date | 2025-11-07 |