NPI | 1255618930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
101YA0400X Counselor, Addiction (Substance Use Disorder) | |
Enumeration Date | 2011-11-09 |
Last Update Date | 2023-05-05 |