| NPI | 1265807515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic |
| 101YM0800X Counselor Mental Health | |
| 273R00000X Psychiatric Unit | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2019-02-28 |