| NPI | 1215300553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 1405) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: LA 1405) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2018-05-24 |