| NPI | 1770772576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 00631) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 001918) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2022-01-24 |