| NPI | 1316367865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2023005068) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2023005068) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2025-01-06 |