| NPI | 1386984177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 9515) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: 4253240) |
| 101YM0800X Counselor, Mental Health (Licence: NH 2374) | |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2022-12-30 |