| NPI | 1205444932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-23404) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 2023-177) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2025-09-26 |