| NPI | 1497270516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA PLC9237) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA PLC9237) |
| 101YM0800X Counselor, Mental Health (Licence: LA PLC9237) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2023-02-01 |