| NPI | 1265596035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH8204) |
| Additional Taxonomies | 104100000X Social Worker |
| 171M00000X Case Manager/Care Coordinator (Licence: FL MH8204) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2018-09-25 |