| NPI | 1770079816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0016143) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 0001759) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2024-03-11 |