| NPI | 1780049940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 1274-124) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2024-09-18 |