| NPI | 1316466840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS AD10-034H) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MS AD10-034H) |
| 251B00000X Case Management (Licence: MS AD10-034H) | |
| 251S00000X (Licence: MS AD10-034H) | |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2017-09-15 |