| NPI | 1063695583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC0538) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC15705) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2024-11-04 |