| NPI | 1194366070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 1194366070) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2022-03-31 |