| NPI | 1265943195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 12806) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 12806) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2024-05-21 |