| NPI | 1184015588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 19597) |
| Enumeration Date | 2015-02-07 |
| Last Update Date | 2026-05-07 |