| NPI | 1871006973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 22196) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2019-06-10 |