| NPI | 1023138617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2016-01-19 |