| NPI | 1952002073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2023-03-15 |