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 |