| NPI | 1497365837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 34001913A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 87000719A) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2020-07-31 |