| NPI | 1336819952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| 175T00000X Peer Specialist (Licence: AK 00000000) | |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2022-11-23 |