| NPI | 1760171268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA PLC9395) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA CIT-5517) |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2023-05-02 |