| NPI | 1811721459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA PLC11022) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA PLC11022) |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2026-02-18 |