| NPI | 1417715186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-04-04 |