| NPI | 1518771229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 61639676) |
| Enumeration Date | 2025-02-03 |
| Last Update Date | 2025-09-25 |