| NPI | 1437040649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-29 |