| NPI | 1104237650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 1307) |
| Enumeration Date | 2014-05-17 |
| Last Update Date | 2018-06-04 |