| NPI | 1396308912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106S00000X Behavior Technician | |
| 175T00000X Peer Specialist (Licence: TX 2512019) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2020-08-11 |