| NPI | 1992253207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2022035117) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: AR A2002033) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2022-09-02 |