| NPI | 1104716901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA CIT-6093) |
| Enumeration Date | 2025-07-04 |
| Last Update Date | 2026-03-12 |