| NPI | 1598141764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC PO15914) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NC P009782) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2021-05-26 |