| NPI | 1710167747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: FL 11435) |
| 171M00000X Case Manager/Care Coordinator | |
| 222Q00000X Developmental Therapist | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2009-10-29 |