| NPI | 1467811067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-1381) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10786) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2025-09-25 |