| NPI | 1619648250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2021-09-23 |