| NPI | 1558923730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2024-04-26 |