| NPI | 1649717026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 251S00000X Community/Behavioral Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2025-09-15 |