| NPI | 1710512736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2024-07-03 |