| NPI | 1700593472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1558) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2024-08-19 |