NPI | 1871939900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
171W00000X Contractor | |
Enumeration Date | 2013-05-15 |
Last Update Date | 2021-11-23 |