| NPI | 1265701098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV 1041C0700X) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2014-02-18 |