| NPI | 1497571442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0710103732) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0704016778) |
| Enumeration Date | 2024-11-25 |
| Last Update Date | 2024-11-25 |