| NPI | 1386502771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2026-01-13 |
| Last Update Date | 2026-02-28 |