| NPI | 1376072330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: NC A714752) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A14752) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2019-06-05 |