| NPI | 1578386363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 2000) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2024-11-01 |
| Last Update Date | 2026-09-22 |