| NPI | 1780338699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor | |
| 103K00000X Behavior Analyst | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2022-02-09 |
| Last Update Date | 2022-02-09 |