| NPI | 1063111607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA PLC9269) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA PLC9269) |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2024-11-12 |