| NPI | 1528841459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACA.0008415) |
| Additional Taxonomies | 172A00000X Driver |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2025-03-10 |