NPI | 1376322875 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
175T00000X Peer Specialist | |
Enumeration Date | 2023-09-25 |
Last Update Date | 2025-06-02 |