| NPI | 1245774512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 9981) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 9986) |
| 251B00000X Case Management (Licence: LA 9986) | |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2018-05-14 |