| NPI | 1235205782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2017-05-02 |