| NPI | 1811573314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 2095) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710103146) |
| 132700000X Dietary Manager (Licence: GA 1230989815) | |
| 171M00000X Case Manager/Care Coordinator (Licence: OK 315103) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2023-08-16 |