| NPI | 1851881452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 7587-125) |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator (Licence: WI 2769-226) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2024-11-18 |