| NPI | 1548000235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710103558) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0704016947) |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-06-24 |