| NPI | 1053722868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA BH001885) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2018-09-28 |