| NPI | 1811432248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TF0200X Psychologist, Forensic | |
| 104100000X Social Worker | |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2017-04-18 |