| NPI | 1598282758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA PLC7036) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA PLC7036) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2022-07-21 |