| NPI | 1023726874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 8875) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA 8875) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2024-09-18 |