NPI | 1376119792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 6018) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C7201) |
101Y00000X Counselor (Licence: LA 6018) | |
Enumeration Date | 2021-05-27 |
Last Update Date | 2024-12-12 |