| NPI | 1194270405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA 16059) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 600720427) |
| 171M00000X Case Manager/Care Coordinator (Licence: LA 16059) | |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2024-08-13 |