| NPI | 1932328804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-07-21 |