| NPI | 1932541810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY 766) |
| 251C00000X Day Training, Developmentally Disabled Services | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2023-06-12 |