| NPI | 1558159756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 04282025100448) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-05-27 |