| NPI | 1629540547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 247000000X Technician, Health Information |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2022-09-20 |