| NPI | 1164036398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 15986) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 15986) |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2021-02-10 |