| NPI | 1306510607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA PLC11131) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA PLC11131) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2026-04-22 |