| NPI | 1790207181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: GA 0033324A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA 0033324A) |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: GA 0033324A) | |
| 171M00000X Case Manager/Care Coordinator (Licence: GA 0033324A) | |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2022-07-21 |