| NPI | 1174060925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1512) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2020-08-13 |