| NPI | 1700638202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 1421-2-1-25A) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172A00000X Driver | |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2025-02-13 |