| NPI | 1568597151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 5731) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2018-12-04 |