| NPI | 1851679633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-6566) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2021-03-03 |