| NPI | 1831654946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1840AD) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2019-02-02 |
| Last Update Date | 2021-03-25 |