| NPI | 1184586760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACA.0008568) |
| Enumeration Date | 2025-12-02 |
| Last Update Date | 2026-06-13 |