| NPI | 1174865059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2024-04-22 |