| NPI | 1841665890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 101YM0800X Counselor, Mental Health (Licence: LA 007657849) | |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2023-06-26 |