| NPI | 1275079378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 225XM0800X) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2022-03-21 |