| NPI | 1427116581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 333L) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IN 28533) |
| 101YP2500X Counselor, Professional (Licence: VA 016701) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2021-08-10 |