| NPI | 1184219727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710102975) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0732007724) |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2021-03-05 |