| NPI | 1740528751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 11121210) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SC 4510) |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2013-01-25 |