| NPI | 1487460507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA PLC10470) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA PLM1573) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2025-09-25 |