| NPI | 1659989572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 87000824A) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IN 34005219A) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2020-07-16 |