| NPI | 1639732860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CMS) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: QMHS) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2019-04-14 |