NPI | 1790393452 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
171M00000X Case Manager/Care Coordinator | |
Enumeration Date | 2020-07-20 |
Last Update Date | 2022-07-07 |