| NPI | 1679889059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH10419) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL MH10419) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2014-04-30 |