| NPI | 1225505613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 5616) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2023-05-23 |