| NPI | 1689219560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2023-05-08 |