| NPI | 1609464692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1949) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2025-03-14 |