| NPI | 1891963229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2023-08-17 |