| NPI | 1548717002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 81-2095355) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2018-08-01 |