| NPI | 1619194644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-02-04 |