| NPI | 1669172953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| 156F00000X Technician/Technologist | |
| 251B00000X Case Management | |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2024-09-12 |