| NPI | 1225796089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1546) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 5275) |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2024-03-28 |