| NPI | 1467949875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2025-03-24 |