| NPI | 1982419347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 171M00000X Case Manager/Care Coordinator | |
| 172A00000X Driver | |
| 103K00000X Behavior Analyst | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-12-08 |