| NPI | 1720609670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0017461) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2020-05-01 |