| NPI | 1336031913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1628) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 8463) |
| Enumeration Date | 2025-07-17 |
| Last Update Date | 2025-07-17 |