| NPI | 1982314993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 104100000X Social Worker | |
| 174400000X Specialist | |
| 251B00000X Case Management | |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2022-11-30 |