| NPI | 1750080164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251B00000X Case Management | |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2023-04-04 |