NPI | 1568907871 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 101Y00000X Counselor |
171M00000X Case Manager/Care Coordinator | |
172V00000X Community Health Worker | |
Enumeration Date | 2016-12-21 |
Last Update Date | 2021-12-15 |