| NPI | 1295746485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI PH-1659) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2018-04-23 |