| NPI | 1629145206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101Y00000X Counselor (Licence: CA XXXX) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2023-07-12 |