| NPI | 1700152568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 1186-3-1-22-606) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1672) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2026-02-18 |