| NPI | 1033418462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2019004054) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2024-09-20 |