| NPI | 1992357214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA 18356) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 18356) |
| 171M00000X Case Manager/Care Coordinator (Licence: LA 18356) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2024-03-20 |