| NPI | 1699518449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 0BHPSS1090) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2025-01-06 |