| NPI | 1619785698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: P133982) |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2025-05-08 |