| NPI | 1497889653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: WI 9350-120) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 9350-120) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2009-08-25 |