| NPI | 1376386136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-06-25 |