| NPI | 1174090484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17123-132) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: WI 253-140) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2024-09-17 |