| NPI | 1538462312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 22822) |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2025-02-16 |