NPI | 1639594302 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: GA 155062) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA172565) |
171M00000X Case Manager/Care Coordinator | |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 03300) | |
Enumeration Date | 2014-03-04 |
Last Update Date | 2023-01-12 |