| NPI | 1154776490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL CBHCMS100032) |
| Additional Taxonomies | 251B00000X Case Management |
| 163W00000X Registered Nurse (Licence: FL RN9412009) | |
| 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS100032) | |
| Enumeration Date | 2016-04-24 |
| Last Update Date | 2023-12-12 |