| NPI | 1629832712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 101Y00000X) |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-06-26 |