| NPI | 1114773561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MD LGA3348) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MD AC1691) |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2024-08-05 |