| NPI | 1669830998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2021-09-09 |