| NPI | 1033695622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 6834) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA PLC6834) |
| 171M00000X Case Manager/Care Coordinator (Licence: LA PLC6834) | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2018-12-03 |