| NPI | 1720258759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: MD 0029858 00) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 11017) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2024-10-07 |