| NPI | 1194484659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 9253) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA PLC9253) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2025-01-14 |