NPI | 1013604206 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: 171M00000X) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
Enumeration Date | 2023-04-19 |
Last Update Date | 2023-04-19 |