| NPI | 1346760972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1594) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: LA LA14-95911) |
| Enumeration Date | 2017-06-24 |
| Last Update Date | 2022-07-21 |