| NPI | 1134758030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-04-03 |