| NPI | 1518788280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0733009089) |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2024-10-31 |