| NPI | 1124570916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS0102603) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: FL MH20962) | |
| 104100000X Social Worker (Licence: FL 0102603) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2023-07-20 |