| NPI | 1346996691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS101164) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL CBHCMS101164) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-02-24 |