| NPI | 1699455501 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK LPCCANDIDATE11788) | 
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator | 
| Enumeration Date | 2023-07-25 | 
| Last Update Date | 2023-10-06 |