| NPI | 1811642762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA D3039778) |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-03-11 |