| NPI | 1376943886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2014-09-10 |