| NPI | 1063888519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: 12853) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2018-09-20 |