| NPI | 1679871289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: UT 7187196-3503) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: UT 7187196-3503) |
| Enumeration Date | 2011-03-05 |
| Last Update Date | 2013-08-15 |