| NPI | 1225636913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 8290) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA PLC8290) |
| 171M00000X Case Manager/Care Coordinator (Licence: LA 8290) | |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2023-01-27 |