| NPI | 1194204412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 10269706-6006) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-55608) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2025-09-18 |