| NPI | 1164106571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA Intern) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2024-09-17 |