| NPI | 1033240643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 58055) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2015-08-27 |