| NPI | 1629201330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 12912) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS100660) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2021-05-24 |