| NPI | 1336586221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 174400000X Specialist | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2018-06-26 |