| NPI | 1184336752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| Enumeration Date | 2022-12-15 |
| Last Update Date | 2023-01-09 |