| NPI | 1134356199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2023-03-07 |