| NPI | 1699140780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: LA 007416367) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2020-11-19 |