| NPI | 1760997100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC A17207) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 21426) |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2022-09-09 |