| NPI | 1669640231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2026-09-10 |