| NPI | 1376206482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA CIT-5353) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA CIT-5353) |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2021-10-22 |