NPI | 1194197574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 101YMO800X) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2015-10-26 |
Last Update Date | 2019-05-23 |