NPI | 1770085706 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH25011) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS100924) |
Enumeration Date | 2018-03-06 |
Last Update Date | 2023-11-14 |