| NPI | 1750990487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-22476) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC LCAS-22476) |
| 102L00000X Psychoanalyst (Licence: NC LCAS-22476) | |
| 171M00000X Case Manager/Care Coordinator (Licence: NC LCAS-22476) | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2023-11-27 |