| NPI | 1316837719 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 106H00000X Marriage & Family Therapist | |
| 146L00000X Emergency Medical Technician, Paramedic | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2025-07-07 |
| Last Update Date | 2025-07-07 |