| NPI | 1245661107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002184) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2023-10-17 |