| NPI | 1396924056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5481) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: SC 101544638) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2014-05-15 |