| NPI | 1861119711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 9046) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 9046) | |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2024-08-21 |