| 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 |