| NPI | 1235720665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1651) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2025-12-16 |