| NPI | 1912542739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CSA0218871) |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2023-01-19 |