| NPI | 1346644507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171W00000X Contractor | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2014-10-17 |