| NPI | 1215309166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 6447) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 6447) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2023-01-02 |