| NPI | 1558826313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 4429) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 1204) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2019-11-25 |