| NPI | 1104450352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CDCA.172918) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2022-03-02 |