| NPI | 1174050199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 14277) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: LA 14277) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2020-09-14 |