| NPI | 1851015077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2022-09-30 |
| Last Update Date | 2023-05-08 |