| NPI | 1831875756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A18873) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 28824-A) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-06-26 |