| NPI | 1659763282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 174400000X Specialist | |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2025-05-08 |