| NPI | 1396116562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: 101yp1600x) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2018-06-01 |