| NPI | 1508214677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KY 268611) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 241972) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2021-02-24 |