| NPI | 1679061378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701015371) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG61015812) |
| 171M00000X Case Manager/Care Coordinator | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2025-10-16 |