| NPI | 1841929387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: 9352) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 9352) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-01-05 |