| NPI | 1164879631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 104100000X Social Worker | |
| Enumeration Date | 2016-05-15 |
| Last Update Date | 2016-05-15 |