| NPI | 1356059844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001672A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34010348A) |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2023-05-11 |