| NPI | 1730885633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 172A00000X Driver | |
| 101YM0800X Counselor, Mental Health | |
| 172V00000X Community Health Worker | |
| 101YP2500X Counselor, Professional | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2023-03-08 |