| NPI | 1053935593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 24235) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 12629) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2020-06-01 |