| NPI | 1073163150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACA.0008361) |
| 172A00000X Driver | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2025-03-10 |