| NPI | 1467014258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-03-10 |