| NPI | 1730526823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000811A) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33000235A) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2023-07-31 |