NPI | 1417203720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
Additional Taxonomies | 106H00000X Marriage & Family Therapist |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-07-24 |
Last Update Date | 2024-09-26 |