| NPI | 1710702220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 14190923-6008) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC 2468) |
| Enumeration Date | 2024-11-19 |
| Last Update Date | 2024-12-10 |