| NPI | 1952052649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 80773) |
| Enumeration Date | 2022-01-13 |
| Last Update Date | 2024-02-13 |