| NPI | 1609321793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC L28489) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: NC 1228757) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2023-04-13 |