| NPI | 1528764370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 99202) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 99202) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2023-02-15 |