| NPI | 1033575279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 7104) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2019-07-01 |