| NPI | 1497335160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA LPC7769) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA LPC7769) |
| 101YP2500X Counselor, Professional (Licence: LA PLC7769) | |
| 171M00000X Case Manager/Care Coordinator (Licence: LA LPC7769) | |
| 171M00000X Case Manager/Care Coordinator (Licence: LA PLC7769) | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2024-02-08 |