| NPI | 1609996743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 0196) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OK 0196) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2021-10-25 |