| NPI | 1831562172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 008398819) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2018-07-24 |