| NPI | 1912617267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OK 320482) |
| Additional Taxonomies | 174400000X Specialist |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2025-03-19 |