NPI | 1063002731 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA R1415700121) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA R1415700121) |
Enumeration Date | 2021-01-26 |
Last Update Date | 2023-10-26 |