| NPI | 1083108153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC CADC-30944) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2024-06-18 |