| NPI | 1669666228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ND 587-8-1-07A) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 247200000X Technician, Other | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2020-09-04 |