| NPI | 1285369678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: CA d2258589) | |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2025-06-03 |