| NPI | 1053028191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 174H00000X Health Educator |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2025-06-13 |