| NPI | 1891459673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2022000008) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MO 2022000008) |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2024-07-18 |