| NPI | 1578129060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 07786-C) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2024-08-02 |