| NPI | 1053735704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 10974) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YP2500X Counselor, Professional (Licence: MI 6401014899) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2023-03-24 |