| NPI | 1568189918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA PLC9877) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health (Licence: LA 1568189918) | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2023-12-14 |