| NPI | 1831511351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 5863) |
| Additional Taxonomies | 104100000X Social Worker |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2023-09-01 |