| NPI | 1497208599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5595) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 5595) |
| 171M00000X Case Manager/Care Coordinator | |
| 171M00000X Case Manager/Care Coordinator (Licence: LA 5595) | |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2024-08-28 |