| NPI | 1962625517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101Y00000X Counselor | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2023-08-03 |