| NPI | 1659743144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 1659743144) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: LA 171M00000X) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2018-07-05 |