| NPI | 1457108128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA CIT-5792) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA CIT-5792) |
| Enumeration Date | 2024-05-01 |
| Last Update Date | 2025-07-07 |