| NPI | 1982419347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103K00000X Behavior Analyst | |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 171M00000X Case Manager/Care Coordinator | |
| 172A00000X Driver | |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-04-25 |