| NPI | 1619389640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017861) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0016075) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2021-12-29 |