| NPI | 1083454045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2025-01-02 |