| NPI | 1114596681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 10474527-3503) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: UT 10474527-3503) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-06-22 |