| NPI | 1235863556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA PLC8804) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251S00000X | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2023-09-13 |