| NPI | 1033955810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA PLC10365) |
| 101YM0800X Counselor, Mental Health (Licence: LA PLC10365) | |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2024-08-28 |