| NPI | 1861366619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106S00000X Behavior Technician | |
| 251B00000X Case Management | |
| Enumeration Date | 2025-10-03 |
| Last Update Date | 2025-10-03 |