| NPI | 1063113975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YP2500X Counselor, Professional (Licence: ND 1585-9-1-26A) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1953) | |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2026-09-14 |