| NPI | 1588961734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 6994329-3503) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2020-11-23 |