| NPI | 1851268536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MD AC2738) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MD LGP16977) |
| Enumeration Date | 2025-10-20 |
| Last Update Date | 2025-10-26 |