| NPI | 1811124704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 101Y00000X) |
| 101YM0800X Counselor Mental Health (Licence: 101YM0800X) | |
| 171M00000X Case Manager/Care Coordinator | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2018-11-02 |