| NPI | 1255879565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1808) |
| Additional Taxonomies | 174400000X Specialist |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2026-10-01 |