| NPI | 1376119792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 6018) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 6018) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2022-08-29 |