| NPI | 1881339273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: LA 5423) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 012121095) |
| Enumeration Date | 2022-05-01 |
| Last Update Date | 2026-04-20 |