| NPI | 1457731655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 17-R-39) |
| 104100000X Social Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2021-06-03 |