| NPI | 1255138541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0704017493) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: VA 0733008439) |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2025-02-28 |