| NPI | 1639873896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC 172V00000X) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2023-06-20 |