| NPI | 1649734955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 173834) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 1280) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA E088) | |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2019-01-31 |