| NPI | 1417206723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701007468) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2026-07-09 |