| NPI | 1215448253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2022-09-29 |