| NPI | 1023489234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP1600X Counselor, Pastoral | |
| 101YS0200X Counselor, School | |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2015-10-14 |