| NPI | 1669113130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM102964) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2022-04-06 |