| NPI | 1043837875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101YM0800X Counselor, Mental Health | |
| 1744R1102X Specialist, Research Study | |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2026-02-10 |