| NPI | 1609402957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 806449) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAC100072) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CET100015) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CRSS100026) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA I0181) | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2020-03-18 |