| NPI | 1134580475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2018-03-17 |