| NPI | 1578135901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106S00000X Behavior Technician | |
| 172V00000X Community Health Worker | |
| 251B00000X Case Management | |
| 251E00000X Home Health | |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2022-09-06 |