| NPI | 1285115139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA 12024) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1403) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2022-06-03 |