| NPI | 1558897512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH24524) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL 0100669) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-10-27 |