| NPI | 1174712533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 372600000X Adult Companion |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2025-10-31 |