| NPI | 1629548201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: LA 1552) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2021-04-16 |