| NPI | 1417313420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 15066) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 000000000000000000) |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2019-01-03 |