| NPI | 1801402847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-25285) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2021-10-25 |