| NPI | 1336702950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2019-08-20 |