NPI | 1255973863 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 3546) |
Enumeration Date | 2019-10-15 |
Last Update Date | 2025-05-29 |