| NPI | 1790711869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710101979) |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701002138) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000900) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-08-12 |