| NPI | 1932572468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA PLC9714) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA 007016682) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2023-11-21 |