| NPI | 1740726876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 9893) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2019-04-11 |