| NPI | 1497249197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-24740) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C013286) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2025-09-19 |