| NPI | 1558874321 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-11-14 | 
| Last Update Date | 2023-06-08 |