| NPI | 1114516093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LC14862) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC14862) |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2024-04-17 |