| NPI | 1376021501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 6358) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2024-01-31 |