| NPI | 1730801689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002594) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2025-03-13 |