| NPI | 1629844741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2026-08-17 |