| NPI | 1386030997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 20064) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2021-10-22 |