| NPI | 1801586144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 4050) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: 00132215) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2023-05-10 |