| NPI | 1023655289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-1605) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR TG-22-078) | |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2022-04-28 |