| NPI | 1992415095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2025-05-29 |