| NPI | 1831617653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PR 4361) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 1203) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2018-12-17 |