| NPI | 1124263744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2014-04-02 |