| NPI | 1639223274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 04-11-33) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2008-01-16 |