| NPI | 1518005669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 2529) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2016-01-10 |