| NPI | 1679014351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 101YMO8OOX) |
| 101YM0800X Counselor, Mental Health (Licence: LA 101Y0800X) | |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2018-05-15 |