| NPI | 1205141710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH3516) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2010-08-10 |