| NPI | 1134700198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 171W00000X Contractor | |
| 374700000X Technician | |
| 376J00000X Homemaker | |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-20 |