| NPI | 1265965420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 1265965420) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: LA 1265965420) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2025-01-24 |