| NPI | 1972145605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TF0000X Psychologist, Family | |
| 104100000X Social Worker | |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2019-10-15 |