| NPI | 1093643157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACD.0002989) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO 0024653) |
| Enumeration Date | 2026-05-11 |
| Last Update Date | 2026-06-10 |