NPI | 1457558900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
Additional Taxonomies | 101Y00000X Counselor |
101YA0400X Counselor Addiction (Substance Use Disorder) | |
Enumeration Date | 2007-06-28 |
Last Update Date | 2024-06-12 |