| NPI | 1356860258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: 171m00000x) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2026-08-27 |