| NPI | 1043859101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA PLC9549) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA PLC9549) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA PLC9549) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2023-05-09 |