| NPI | 1609363126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701007601) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710102138) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000469) | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2025-12-02 |