| NPI | 1689193351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA LPC7157) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA PLC7157) |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2018-10-14 |