| NPI | 1952498321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 7146) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA 151) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 965) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2023-07-20 |