| NPI | 1730859638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC AADC-2138) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC ADC-2111) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2024-02-26 |