| NPI | 1548730740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 175T00000X Peer Specialist | |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2024-03-14 |