| NPI | 1609347285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 171M00000X Case Manager/Care Coordinator | |
| 171W00000X Contractor | |
| 175T00000X Peer Specialist | |
| 225C00000X Rehabilitation Counselor | |
| 251B00000X Case Management | |
| 251X00000X | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2018-12-07 |