| NPI | 1770098139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 175461) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 86000431A) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710103608) | |
| 101YM0800X Counselor, Mental Health (Licence: VA 0732008841) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2023-02-13 |