| NPI | 1184171654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 9325) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-10-20 |