| NPI | 1053747162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 1360) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1360) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2018-05-18 |