| NPI | 1023445533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000544) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 000544) |
| Enumeration Date | 2013-09-28 |
| Last Update Date | 2025-03-15 |