| NPI | 1821623000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other (Licence: NC 497657) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC ON99XS11X5) |
| 101YP2500X Counselor, Professional (Licence: NC ADCK9AERA5) | |
| 237700000X Hearing Instrument Specialist (Licence: NC 497657) | |
| Enumeration Date | 2020-03-07 |
| Last Update Date | 2022-05-07 |