| NPI | 1245837327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: PR 1671) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR TAC-III-05-20-2620) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2022-01-20 |