| NPI | 1942674411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA 17790) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 17790) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-11-21 |
| Last Update Date | 2025-05-08 |