| NPI | 1164778874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS.0100116) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2023-05-12 |