| NPI | 1194992552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: UT 5529290-6004) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2024-02-01 |