| NPI | 1831745405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-25696) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC P013818) |
| Enumeration Date | 2019-08-10 |
| Last Update Date | 2023-04-20 |