| NPI | 1174861579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 251B00000X Case Management | |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2013-01-21 |